Cardiac Tamponade

Annotations:

• Cardiac tamponade is pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle (myocardium) and the outer covering sac of the heart (pericardium).

1. Causes
   1. Other causes

      Annotations:

      • Cardiac tamponade occurs in about 2 out of 10,000 due to disease
      1. Heart tumors
      2. Hypothyroidism
      3. Kidney failure
      4. Leukemia
      5. Placement of central lines
      6. Radiation therapy tothe chest
      7. Recent invasive heart procedures
      8. Recent open heart surgery
      9. Systemic lupus erythematosus
   2. Heart attack
   3. End-stage lung cancer
   4. Dissecting aortic aneurysm (thoracic
   5. Heart surgery
   6. Pericarditis

      Annotations:

      • Caused by bacterial or viral infections
   7. Wounds
2. Symptoms
   1. Other symptoms
      1. Dizziness
      2. Drowsiness
      3. Weak or absent pulse
   2. Chest pain

      Annotations:

      • Felt in the neck, shoulder, back, or abdomen
   3. Anxiety
   4. Problems breathing
   5. D/C

      Annotations:

      • relieved by sitting upright or leaning forward
   6. Fainting
   7. Pale, gray, or blue skin
   8. Palpitations
   9. Swelling

      Annotations:

      • Abdomen or other areas
3. Exams and Tests

   Annotations:

   • There are no specific laboratory tests that diagnose tamponade. Echocardiogram is very often used to help make the diagnosis. This test may be done at the bedside in emergency cases.
   1. Physical exam
      1. Pulsus paradoxical

         Annotations:

         • Blood pressure that falls when breathing deeply
      2. Rapid breathing
      3. HR over 100
      4. Barely audible heart sounds
      5. Distended neck vein

         Annotations:

         • but the BP is low
      6. Weak peripheral pulses
   2. Other tests
      1. MRI of chest
      2. Chest x-ray
      3. Coronary angiography
      4. ECG
      5. Right heart catheterization
4. Treatment
   1. Pericardiocentesis

      Annotations:

      • The fluid around the heart must be drained as quickly as possible.
   2. Surgical intervention

      Annotations:

      • A surgical procedure to cut and remove part of the pericardium may also be done. This is known as surgical pericardiectomy or pericardial window
   3. Medications

      Annotations:

      • Fluids are given to keep blood pressure normal until the fluid can be drained from around the heart. Medicines that increase blood pressure may also help keep the person alive until the fluid is drained.
   4. O2

      Annotations:

      • Oxygen may be given to help reduce the workload on the heart by decreasing tissue demands for blood flow.
5. Prognosis

   Annotations:

   • Cardiac tamponade is a medical emergency. If the fluid or blood is not quickly removed from the pericardium, death can occur quickly. The outcome is often good if the condition is treated promptly. However, tamponade may come back.
6. Complications
   1. Heart Failure
   2. Pulmonary edema
   3. Shock
   4. Death
7. Nursing Responsibilities
   1. Patient Monitoring

      Annotations:

      • 1.Continuously monitor ECG for dysrhythmia formation, which may result of myocardial ischemia secondary to epicardial coronary artery compression. 2.Monitor the BP every 5 to 15 minutes during the acute phase. 3.Monitor for pulsus paradoxus via arterial tracing or during manual BP reading. 4.Monitor urine output hourly; a drop in urine output may indicate decreased renal perfusion as a result of decreased stroke volume secondary to cardiac compression.
   2. Patient Assessment

      Annotations:

      • 1.Assess cardiovascular status: monitor for jugular vein distention and presence of Kussmaul’s sign. 2.Note skin temperature, color, and capillary refill. 3.Assess amplitude of femoral pulse during quiet breathing. 4.Assess level of consciousness for changes that may indicate decrease cerebral perfusion.
   3. Diagnostic Assessment

      Annotations:

      • 1.Review ECG for electrical alterans. 2.Review echocardiogram report if available. 3.Review chest radiographs
   4. Patient Management

      Annotations:

      • 1.Provide supplemental oxygen as ordered.Initiate two large-bore intravenous lines for fluid administration to maintain filling pressure. 2.Pharmacologic therapy may include dobutamine to enhance myocardial contractility and decrease peripheral vascularresistance. 3.Monitor the patient for dysrhythmias, coronary artery laceratio.Surgical intervention to identify and repair bleeding site, to evacuate clots in the mediastinum, to resects or open the pericardium.